Jan 12, 2018 in Health

In Defense of Julie Thao

Medication Errors in Nursing Practice

The safety of patients is the most important aspect that professionals in the healthcare field focus on. Studies have indicated that medical care complications, as well as, adverse effects associated with medical care arise due to human errors or system errors during the period in which the patient is hospitalized (Burris, Brennan, Leape & Laird, 1991). According to a study done by the Institute of Medicine, between 44000 and 98000 patients lose their lives in the U.S.A every year because of errors that are medical in nature. These figures are so high that it has made medical errors to be ranked as the number eight cause of deaths in the United States of America (Kohn, Corrigan & Donaldson, 2000).

From these values, it is important that lessons are learned from such errors by the system and by the people in the system. It is prudent that these experiences are considered as learning opportunities that medical practitioners can learn from in order to ensure that hospitals are safer than they currently are. The criminalization of medical errors, however, has made the reporting of errors to be viewed negatively. The case of Julie Thao is a case in point in which a medical practitioner was charged for such an error. This paper will focus on the defense of Julie Thao and the reasons why medical errors are human errors and should not be criminalized. Furthermore, the paper will discuss the reasons why nurses are more prone to making medical errors than other medical practitioners and why the fault lies in the system rather than the nurses.

The Criminalization of Medical Errors

The criminalization of medical errors and the prosecution of healthcare practitioners such as Julie Thao has struck fear among many nurses all over the country. The effect of this is the underreporting of such errors, which would have been used as a learning base to avoid such errors in the future and protect more patients from suffering the same fate. Whether a nurse is the cause of the error, or he/she contributed to the error or merely observed as the error was made, it is their moral duty to report the said error. However, there are numerous studies that have indicated that nurses are underreporting these cases (Gladstone, 1995). Based on these studies, it was observed that nearly 95% of all the medication errors were not reported because the nurses feared the punishment that would go along with the mistake (Hume, 1999). Furthermore, nurses who reported medical errors stood to lose their jobs. The tainting of the nurse's reputation as the person who caused an error also causes many cases to go unreported. Furthermore, the general fear for the medical institution's reputation causes even fewer cases to be reported.

The Julie Thao Case

The Julie Thao case was one that can be considered as pure blame throwing and scapegoating of a nurse without any intent to cause bodily harm nor cause the loss of the patient she was caring for. Julie Thao was a delivery nurse stationed at St. Mary's Hospital located at Madison, Wisconsin. The date that the error was committed was on 5th July 2006. On the said date, the nurse was voluntarily working a back-to-back double shift. She was taking care of a patient, Jasmine Gant who was 16 years old and about to deliver her baby. Gant had an infection and had the nurse was meant to administer a four regimen antibiotics set. She was also to administer an epidural anesthetic. However, reports indicate that Gant appeared anxious with regard to the epidural anesthetic (Burris, Brennan, Leape & Laird, 1991). Therefore, in order to calm her patient, the nurse removed it from the Pyxis machine and brought it to her patient for her to see. There was a label on the bupivacaine that warned against administration intravenously. Additionally, there was a barcode reader used for the administration of medication.

However, due to the rush of the moment and the haste of the moment, the nurse bypassed the barcode and did not see the warning label of not administering the anesthetic intravenously.

She went on to administer the anesthetic intravenously instead of the antibiotics. Her patient, Gant, lost her life a few moments later. However, the doctors were able to save her baby by performing a caesarian section. While the hospital apologized to the family of Gant, Julie Thao was prosecuted and her license was suspended.

To err is human and, therefore to criminalize genuine human error is unfair. Just as is the case of Nurse Julie Thao, it was evident that there was no intent to cause any harm to her patient. Nurses are being heavily burdened and at the same time being asked to be perfect at what they do. To go ahead and criminalize errors that may result from the overload makes the situation even much worse than it currently is.

Why Nurses Are Highly Prone to Making Medication Errors?

There are several reasons as to why nurses are highly prone to making medication errors than any other healthcare giver. While these may not be excuses for recklessness, they give a good indicator as to why even dedicated, compassionate and hardworking nurses may make mistakes without intending to make the mistake. To begin with, nurses work long continuous shifts. For instance, in Julie Thao's case, she had worked two back-to-back shifts. As a result, nurses are overworked and get fatigued. Fatigue is a major cause of reduced vigilance, the challenge in decision making, as well as, processing of information. This means that for a person who has to work for 12-hour shifts and has a long distance to commute, then they may have to be awake for nearly 18 hours. Due to the shortages in nurses, these long work hours are necessary and inevitable. The nurses voluntarily offer these long work hours due to the dedication and compassion for the human situation (Kohn, Corrigan & Donaldson, 2000).

This is a sacrifice that not many people are willing to offer. However, the nurses are continuously being blamed for the errors that may result from the fatigue caused by such extensive work hours.

Due to the shortage of nurses, the current nurses are required to take care of a huge number of patients. In one shift, a single nurse is responsible for more than two patients. Each of these patients depends on the same nurse for quality care throughout. It is not possible for the nurse to be at their peak considering this situation in which they have to focus on more than one individual at a time. Therefore, the chances of making an error increase ten-fold as they have to shift concentration from one patient to the other.

As a result of the fatigue that nurses undergo, there are chances that they may experience "in attentional blindness". This may lead to the nurses misreading the labels on the drugs and end up administering the wrong drug. Furthermore, the fact that the nurse is fatigued, they may end up not carefully checking the drug to be administered and may end up administering the wrong drug. Due to the number of activities that the nurse is expected to simultaneously handle during the shift, there is a chance of numerous errors. This is major because the nurse is interrupted and their focus not oriented towards a single task (Hume, 1999)

Nurses are also overloaded with other tasks that make them be away from the patient's side. For instance, nurses may be required to answer phone calls, they may also be required to clean the rooms in which the patients are in, and are also involved in the delivery of the meal trays of the patients. This causes the attention of the nurse directed towards the patient to be greatly reduced and, therefore, their efficiency is highly curtailed.

While the consequences of medical errors are grave, the generalization that the errors were intentional is wrong. Therefore, to criminalize these errors is tantamount to prohibiting other hopeful individuals from joining the noble profession. Unless it is a case of sabotage or willful harm to the patient, such cases should be treated as general accidents and human errors caused by faults in the system and the fact that humans are not 100% perfect. It is also not possible to fully eliminate such problems with the current system in which there are few nurses compared to the number of patients and the services they are expected to render. Additionally, nurses will fear to report any errors made as they fear the consequences and going to prison. This is detrimental to the profession as a whole since errors from which lessons could be learned to prevent future errors will go unreported. This also means that patients are going to continue suffering (Hume, 1999).

How to Avoid the Errors in Nursing Practice

There are plausible solutions that can be applied rather than inadvertent punishment for mistakes that can be made by any human in the same situation. To begin with, it is important that nurses are regularly re-trained and undergo special courses targeted at minimizing errors. It is also important that the government invests in the nursing profession to increase the number of nurses in hospitals. This will greatly reduce the workload and work hours required for nurses. Finally, the establishment of effective quality processes, as well as, strategies for risk management will go a long way to ensure that medical errors are minimized. Blame throwing does not solve the problem. In fact, it only aggravates the already worse situation. Criminalization only appears as a form of scapegoating and also serves to harm the profession than benefit the stakeholders.

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